颏水平截骨联合置入假体治疗严重小颏畸形

目的介绍一种治疗严重小颏畸形,重塑颏部外形的有效方法.方法采用口内切口颏部水平截骨前移固定后,再联合利用在颏部置入合适假体的隆颏术,以进一步增加颏突度和颏长度,改善颏部形态.结果共治疗9例,术后患者颏部形态均得到明显改善,重塑的颏部外形符合美学标准,达到患者术前的预期要求.随访6个月至2年,效果稳定满意,无明显并发症出现.结论利用颏水平截骨联合置入假体的颏成形术治疗严重小颏畸形,使重塑的颏部形态达到了美学标准,面部轮廓比例协调,效果显著.     

假体隆颏术后骨吸收的原因分析及治疗

目的探讨假体隆颏术后颏部骨吸收的可能原因及治疗。方法分析假体隆颏术后因骨吸收进一步治疗患者i2例,通过临床于术所见和放射学检查结果,观察局部颏骨吸收情况。结果发生轻度或无骨吸收者7例骨吸收（≤2mm）,其中硅橡胶假体5例,膨体聚四氟乙烯假体2例。发生中度骨吸收者3例（骨吸收〉2mm,而≤4mm）,均为硅橡胶假体。发生重度骨吸收者2例（骨吸收〉4mm）,硅橡胶假体1例,膨体聚四氟乙烯假体1例。所有患者均接受假体取出术,其中8例行颏成形术．2例行高密度多孔聚乙烯隆颏术进一步治疗,效果满意。结论颏肌假体一骨之间的平衡失调是引起骨吸收的最主要原因之一。因此,对于轻度和中度小颏畸形可以选用合适的假体进行隆颏术,但需长期随访观察,对于重度的小颏畸形,或伴有黯颌面畸形和颏肌功能亢进的小颏或者小下颌患者不应选用假体隆颏术。否则,会发生严重骨吸收,需要采用截骨成形术进行矫正。     

改良颏截骨前徙联合假体置入治疗小颏畸形

目的 介绍一种改良的颏截骨术联合假体置入治疗小颏畸形,使隆颏术后颏部具有更佳的美容效果.方法 选择口内切口入路,采用改良的颏部水平"几"型截骨后前徙内固定术,并联合置入合适假体,达到改善颏部后缩,延长颏突度和颏长度,同时改善颏正中区域外形.结果 采用该方法共治疗11例患者,其中3例行单纯颏截骨前徙术,8例行颏截骨前徙联合假体置入术,术后颏部形态均得到明显改善,患者满意度高.结论 改良颏截骨前徙联合假体置入治疗小颏畸形,可以明显改善患者的面部外观,重新建立颏部美容曲线,效果满意.     

颏成形术发展及现况

颏部是维持面部平衡和协调的重要元素,大小和空间位置的变化可导致各种畸形。颏成形术是最早开展的颅颌面轮廓整形之一,主要包括假体植入隆颏术、自体骨植入隆颏术和颏截骨成形术。近年来,计算机辅助外科、机器人外科及3D打印技术开始应用于颏成形术中。本文对颏成形术的发展及现况进行综述。     

自体下颌角骨移植隆颏术

目的:介绍自体下颌角骨隆颏术。方法:在下颌角肥大患者截除下颌角后,根据颏部形态要求,将下颌角骨打磨塑形,用钛钉固定于颏部。结果:自2000年来共完成61例自体下颌角骨移植隆颏术,术后随访3月～2年,形态满意60例,不满意1例。结论:下颌角肥大伴有小颏畸形患者行下颌角骨移植隆颏是一举两得的好方法。     

高密度多孔聚乙烯假体置入隆颏在面下1／3轮廓成形术中的应用

目的探讨高密度多孔聚乙烯（porous high-density polyethylene,Medpor）假体置入隆颏在面下1／3轮廓成形术中的应用效果。方法149例同时行口内入路Medpor假体置入隆颏及面下1／3轮廓整形,其中行双侧下颌角截骨成形术121例,行双侧下颌角截骨成形术及双侧颧骨截骨降低术28例,并进行术前术后照相对比,观察判断临床效果。结果术后145例（97．3％）颏部外形及面下1／3轮廓改善满意。2例（1．3％）感觉颏部突度改善欠佳,其中1例再次行Medpor假体取出及颏部截骨前移颏成形术。1例（0．7％）感觉颏部假体偏大,行二次手术将假体修小;1例（0．7％）术后6个月因假体偏斜改行颏部截骨颏成形术。20例（13．4％）术后短期感觉下唇麻木,1～3个月后基本消失。随访期间没有发现伤口血肿、感染及假体外露、断裂等并发症。结论Medpor假体组织相容性好,同时经口内入路置入隆颏及下颌角截骨成形术在面下1／3轮廓整形中效果良好。     

经口内切口硅胶体隆颏术30例报告

颏短小畸形成形术主要有骨水平延长或加植骨颏成形术、硅胶体植入增大颏成形术以及其他一些方法。笔者所在医院自１９９５年２月至１９９８年２月对单纯颏部短小畸形的病例采用经口内横切口行硅胶体隆颏术共３０例，取得了较满意的效果，现报道如下。１临床资料本组３０例，男性６例，女性２４例，年龄１８岁～２７岁。均为先天性颏短小畸形，且无明显咬合错位畸形者。采用国产医用硅胶模型植入１９例，硅胶块术前自行设计雕塑者１１例。２手术方法手术前按患者颏部畸形轻重程度用美蓝标出所需充填范围，选择合适的硅胶体，如成品不适用，则…     

口内双侧横行小切口隆颏术

目的:探求一种通过口内双侧横行小切口使假体置入更加方便准确、减轻术中损伤及术后并发症的隆颏手术新方法。方法:根据颏部解剖结构特点,采用口内双侧粘膜上横行小切口,切口定位于双侧尖牙下方距唇龈沟5mm处,长约8mm。横行切开粘膜及粘膜下组织,分别从两侧粘膜切口纵行向下钝性分离肌层至骨膜,用剥离子在骨膜下剥离拟置入假体腔隙,假体置入后肌层及粘膜分层缝合。结果:笔者采用该切口进行硅胶假体置入隆颏术共3例,切口均Ⅰ期愈合,未出现明显术后并发症。随访1～6个月,均获得满意效果。结论:采用经口内双侧横行小切口进行硅胶假体隆颏术对矫正McCarthyⅠ型轻度小颏畸形可获得满意术后效果,且保留颏部肌肉完整性并避开颏神经,创伤小,有利于减少术后并发症等优点。     

口内纵行小切口硅胶假体隆颏术

目的：探讨应用口内纵行小切口硅胶假体隆颏术和减少手术并发症的方法.方法：根据颏部解剖特点借鉴隆鼻术的手术技巧，采用口内单一纵行小切口颏骨膜下隆颏术，矫治轻、中度小颏畸形126例.结果：本组126例，随防78例，6个月至8年.外形满意，无一例假体裸露.结论：应用口内纵行小切口硅胶假体隆颏术具有切口隐蔽，损伤小、并发症少、简便易行等特点，适合轻、中度小颏畸形的矫正。     

颏部缩窄截骨结合Medpor隆颏矫正颏部宽大后缩畸形

目的：探讨一次性矫正颏部宽大及颏部后缩畸形的方法。方法：应用颏部缩窄截骨结合高密度多孔聚乙烯（Medpor）隆颏矫正颏部宽大后缩畸形患者11例。结果：11例患者颏部宽大及后缩畸形得到矫正,效果满意。结论：颏部截骨缩窄结合Medpor隆颏可一次性矫正颏部宽大及颏部后缩畸形,解决了单纯颏部截骨术后或单纯隆颏术后局部不能达到最佳的手术效果的弊端。     

Genioplasty and Chin Augmentation with Medpore Implants: A Report of 650 Cases

Background Genioplasty is an old and useful technique. Chin augmentation with Medpore has become popular in recent years. The authors briefly examine their experience with the two techniques. Methods From 2000 to date, 500 genioplasties and 150 chin augmentations with Medpore have been performed. The versatility and benefits of the two techniques are discussed. Results Most of the patients achieved satisfactory results with few complications. Genioplasty is recommended for severe developmental or complicated retrogenia and for deviated chin. Both techniques can be used for mild to modest retrogenia. Medpore is especially useful for patients who need a meticulous revision of the chin shape or contour. Conclusions Chin shape and contour are as important as the chin position. Although genioplasty has the widest range of indications, chin augmentation with Medpore has the advantage of minimal risk for some patients who need to change the chin shape or contour. Medpore is totally different from other alloplastic chin implants such as silicone.     

颏部透明质酸注射填充术

目的介绍一种应用透明质酸产品进行颏部注射填充的方法。方法本组共30例颏部短小的患者,在表面麻醉下选用30G细针头进行颏部透明质酸注射填充治疗。透明质酸用量为2．0～3．0m1,平均2．4ml。其中1例患者因颏肌紧张,曾预先行颏肌肉毒毒素注射治疗。治疗后评价颏部填充效果及面部轮廓的改善程度。随访至治疗后6个月。结果本组30例患者,颏部填充后的隆起效果明显,面部轮廓改善,符合审美要求,患者对外观满意。注射治疗后颏部肿胀程度较轻,一般在治疗后第3天达到高峰,在4～7d逐渐消退。未发现外形不对称、局部感染、血肿、皮肤坏死及填充剂过敏情况。填充效果可维持6个月以上。结论应用透明质酸产品注射填充矫正颏部短小,是一种安全、有效的治疗方法,易被医师及患者接受,操作简单,便于推广。     

自体下颌骨隆颏术

目的　探讨颏部美容术的一种新方法。方法　口内入路 ,将双侧下颌角骨质或下颌骨外板取出 ,根据颏部具体情况及患者主观意愿 ,将骨块修整成适当形状 ,移植于颏部 ,以钛钉或钛板作坚强内固定。结果　 2 0 0 0年 1月～ 2 0 0 3年 1月我们共收治 30例患者 ,其中 2 0例行双侧下颌角截骨 自体下颌骨移植隆颏术 ,10例行双侧下颌骨外板截骨 自体下颌骨移植隆颏术。术后伤口愈合良好 ,颏部形态满意。结论　自体下颌骨移植隆颏 ,无排异等不良反应 ,移植骨块与颏部能牢固愈合 ,术后效果满意 ,是一种理想的颏部美容手术方法。     

口内单侧纵切口e-PTFE隆颏术疗效观察

目的:阐述口内单侧纵切口e-PTFE隆颏术,观察其临床疗效。方法:对23例轻中度小颏畸形的患者,采用口内单侧纵切口,配合自制改良剥离子行e-PTFE隆颏术。结果:所有就医者随访6个月~2年,术后切口均一期愈合,无感染、假体排异、变形、移位等不良后果产生,外形满意。结论:口内单侧纵切口e-PTFE隆颏术是一种安全、有效、简便的纠治小颏畸形的手术方法。     

A simple procedure to facilitate chin implants placement via submental approach

Abstract

In order to facilitate chin implants placement by submental incision, the use of two threads is described. They are separately passed through the extremities of the implant and inserted into the previously created subperiosteal pocket using a grooved guide. Once the landmarks of dissection have been reached, the tip of the needle exits through the skin just a few centimetres laterally to the augmentation area and, only by pulling the free ends of the threads, the implant can easily be inserted into the pocket and the sutures cut and removed. This procedure was successfully performed in 79 patients of both sexes presenting with deficiencies in the sagittal dimension at the pogonion and in width, laterally to the symphysis. Therefore, in the authors' opinion, the before-described technique could be a useful tool that facial plastic surgeons can employ to facilitate alloplastic chin implants placement, by minimising the invasiveness of the procedure, reducing the operative time, and greatly improving the aesthetic result, without sacrificing the safety of the operation.     

Chin augmentation using diced cartilage

Eight patients with microgenia have undergone augmentation with diced nasal cartilage. Cartilage grafts were harvested from the nose during rhinoplasty. These grafts were cut into 0.5 to 1.0 mm pieces using a #11 blade and were wrapped in one layer of Surgicel (oxidized regenerated cellulose). This cartilage mass was inserted into the chin pocket. All patients underwent clinical evaluation, magnetic resonance imaging (MRI), and photography. These investigations showed that diced cartilage grafts maintained 75% of their dimensions at six months after implantation. The follow-up period was 12 months, and the aesthetic results were satisfactory. Received: 5 May 1997 / Accepted: 21 August 1997     

HTR® polymer facial implants: A five-year clinical experience

Forty-three patients at two different international sites underwent onlay facial augmentation of the malar, paranasal, and chin regions using 61 HTR polymer preformed implants. All implants were placed intraorally and rigidly fixed with a titanium screw. Over postoperative periods ranging from two to five years, one implant was removed because of infection. Two other implants in patients with rheumatic and connective tissue disease were removed because of persistent pain and erythema. Another peri-implant infection was treated successfully without removal. Oneyear postoperative radiographs in patients with chin implants demonstrated no underlying bone resorption. This porous polymeric material appears to offer clinical results comparable to other alloplastic materials for onlay facial skeletal augmentation.     

下颌截骨整体塑形术

目的　为使不同类型“方形脸”者达到下颌截骨术后下颌整体形态的协调美观。方法根据不同类型的下颌角肥大 ,在下颌骨截骨的基础上联合应用下颌缘截骨、下颌骨半环形截骨以及下颌自体骨隆颏等综合手术方法改善下颌整体形态。结果　自 1996年以来共收治 312例 ,其中下颌角联合下颌缘截骨 2 0 0例 ,单纯下颌缘截骨 2 3例 ,下颌骨半环形截骨 15例 ,下颏修尖 9例 ,下颌自体骨隆颏 32例。对其中 15 0例随访 1～ 12个月 ,满意率 97%。结论　综合的下颌截骨方法可使方形脸术后下颌整体效果协调美观。